DHCS issued this update earlier this week indicating that the claw back would begin no earlier than August 28th and providing more details on the information that will be given to providers at the beginning of the process. CAMPS has joined with CPhA in providing a list of questions to DHCS on how the claw back will be applied in a variety of situations, i.e. provider is no longer billing fee for service Medi-Cal or is no longer in business and many other questions. Once we have additional information it will be provided. Here is the update and a notice is also posted on the Medi-Cal website.

Implementation for the recoupment of AB 97 related reductions to pharmacy providers is being rescheduled to begin no sooner than August 28, 2015. Under the process developed for this recoupment, Providers will initially receive supporting claim detail (in the form of a Remittance Advice Detail (RAD)) informing them of the total amount due. Receipt of the RAD will then be followed (approximately two weeks later) by the first five percent withhold from the provider's weekly check-write. The recoupment will be effectuated through the department's normal Erroneous Payment Correction (EPC) process. Due to the volume of claims associated with this recoupment, DHCS will be rolling this EPC out over the course of approximately sixteen weeks; therefore, not every pharmacy provider will be impacted at the same time. Efforts have been undertaken to ensure all claims for each provider will be processed during the same or consecutive weeks, if necessary (depending on claim volume for that provider).

This update has been posted to the Pharmacy Benefits Division webpage under "Hot Topics". Additional information related to the AB 97 reductions can be found on the DHCS AB 97 webpage.

Questions specific to the AB 97 EPC process should be directed to the Telephone Service Center at 1-800-541-5555, option 1 (for English), option 1 (for Provider), option 5 (for HAP, Family PACT, CHDP, CCS, GHPP, Crossover, LTC and other general billing inquiries), followed by option 6 (for general billing).